Mahmoud Elayan, the director general for Palestine Red Crescent Society (PRCS), looks tired as he sits behind his desk at PRCS’ medical center in occupied East Jerusalem. He had to be up at five in the morning to make it to the hospital in time for work.

“I live ten minutes from here,” he says. “But now it takes an hour to reach my home because of the checkpoints,”

Elayan’s job is taxing at the best of times, but the last few weeks have presented additional challenges: Israeli forces have seriously hindered the provision of medical care to Palestinians in East Jerusalem, stopping ambulances at checkpoints, harassing medics and violating patient privacy.

The restrictions come following an announcement by Israeli Prime Minister Benjamin Netanyahu, Oct. 14 authorising Israeli police to close or surround areas in East Jerusalem that pose a security threat.

“After Oct. 14, everything's getting worse. This is the first time Israel are doing this. Before they would only put temporary barriers in Jerusalem. But this time it is permanent,” said Elayan.

According to the UN monitoring group OCHA, Israel has placed 38 obstacles on East Jerusalem roads, including 16 checkpoints, directly affecting nine Palestinian neighborhoods with a combined population of 138,000.

Two of these checkpoints are located directly next to PRCS’ premises on the Mount of Olives.

In a statement on Oct 21. B’Tselem, an Israeli human rights center, condemned the checkpoints as a form of collective punishment that, “primarily harms the most vulnerable members of society.”

The closures follow an escalation in violence across Jerusalem, the West Bank and Gaza, beginning in October, triggered by Israeli incursions into Al Aqsa mosque.

Mohamad Abu Ganam, an ambulance driver with PRCS, says he experiences daily harassment and restrictions imposed by Israeli soldiers while working in the field.

Since the barriers were put in place in East Jerusalem this daily restriction of movement has been shifted to the hospital’s doorstep, hindering Ganem's access to patients in need of urgent medical attention in East Jerusalem.

Ganam recounted an incident last week, in which he responded to a call of a semi conscious person in the East Jerusalem neighborhood of Beit Hanina. Israeli solidiers ordered the team to stop and exit the ambulance.

“The soldier told me, 'I don’t care if the case that you are responding to is urgent, I care if you are a terrorist,’” said Ganam.

The team was forced to call the PRCS dispatch center to tell them to send another ambulance.

“We could not reach the patient and we had to go back. We wasted fifteen minutes at the checkpoint, that is enough time for someone to die,” Ganam explained.

In a medical emergency, these delays can mean the difference between life and death.

According to Elayan, since the barriers were put in place, two Palestinians from East Jerusalem have died after the ambulances responding to their cases were delayed at a checkpoint.

On Oct. 19, a 65 year old Palestinian woman suffering from respiratory problems, after inhaling tear gas fired by Israeli soldiers, died following delays at a checkpoint in the East Jerusalem neighborhood of Issawiya.

According to Human Rights Watch, Israeli police had sealed the roads leading from her neighborhood to the nearest hospital, turning what is normally a six-minute drive to the hospital into a journey of at least 45 minutes.

“The ambulance stayed at the checkpoint for one and half hours,” said Elayan.

“She was in a car with her sons on one side of the barrier. Our ambulance was on the other side and could not reach them.”

Alongside the restrictions placed upon paramedics and ambulances in the field, Palestinians in need of medical treatment have struggled to gain access to the hospitals in East Jerusalem.

According to Elayan, earlier this week two pregnant Palestinian women in labour were forced to abandon their car and walk to the PRCS hospital after being prevented from going through the barrier by car.

Given the restricted access to PRCS’ hospitals and the harassment staff often face at checkpoints, an increasing number of Palestinian patients are opting to go to Israeli hospitals in West Jerusalem instead.

This is problematic, according to Elayan, as Palestinians generally feel more comfortable in East Jerusalem’s Arab hospitals, where they share a common language and religion with the staff and fellow patients.

He added that during times of intensified political contention between Palestinians and Israeli soldiers, Palestinians are less likely to go to an Israeli hospital as they are frequently faced with discrimination and abuse.

Despite this, in the month of October, 80 female patients registered to give birth at their hospital cancelled appointments with PRCS. According to Elayan, when the hospital called up to enquire about their absence, the main reason was attributed to the Israeli barriers and the accompanying harassment in East Jerusalem.

Checkpoints have further hampered daily hospital activity by discouraging Israeli companies from providing medical supplies and services to the Palestinian hospitals in East Jerusalem.

According to Elayan, since the checkpoints were erected, Israeli service providers refuse to deliver to East Jerusalem hospitals, fearing the area is too dangerous and the barriers and checkpoints make accessing the hospitals particularly inconvenient.

One of these services is biohazardous waste removal.

“The biohazards of the hospital should be removed every three days, but now it stays for one and a half weeks,” says Elayan. “It becomes very dangerous and smells very bad.”

The hospital now has to rent a car and take the waste to West Jerusalem, where they can deposit the waste with the Israeli company to effectively dispose of.

According to him, the hospital now has to pay an additional 1200 NIS (300 USD) a week for a driver to take the waste to West Jerusalem.

With East Jerusalem hospitals already financially strained under the burgeoning debt of the Palestinian Authority, these extra costs are worrisome, said Elayan.

“We are already in financial crisis, this extra money that has been created from the barriers has produced more burden on the hospitals,” he said.

According to PRCS, these checkpoints and roadblocks violate the basic human rights enshrined in International Humanitarian Law and International Human Rights Law, including the right to receive and access regular and emergency medical care.

An Oct. 21 a report by Human Rights Watch condemned the lack of measures taken by Israeli authorities to ensure direct roads to hospitals were kept open, saying it “raises concerns that the travel restrictions may violate residents’ right to health, as well as freedom of movement.”

Last week, Israeli soldiers began taking down some barriers surrounding neighbourhoods in East Jerusalem. However, according to Elayan, while this has eased the situation, the main barriers by the hospital remain.

With these in place, the daily running of the hospital and ambulance services continue to be disrupted, the provision of Palestinian medical care dictated by the mood of the Israeli soldier at the checkpoints within East Jerusalem, as well as the West Bank.

“There is no law on this side, there is no traditional way to treat ambulances and medical staff,” said Ganam.